| NPI | 1073953543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: FL AP3241) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA18793) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2026-02-16 |